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Cavicchiolo ME, Brigiari G, Nosadini M, Pin JN, Vincenti A, Toldo I, Ancona C, Simioni P, D Errico I, Baraldi E, Sartori S. Cerebral venous thrombosis and deep medullary vein thrombosis: Padua experience over the last two decades. Eur J Pediatr 2024; 183:3461-3470. [PMID: 38780653 DOI: 10.1007/s00431-024-05602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT. MATERIALS AND METHODS Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol. RESULTS Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8 days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up. Conclusion: DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Via Giustiniani 3, 35128, Padua, Italy.
| | - Gloria Brigiari
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Jacopo Norberto Pin
- Division of Neuropediatrics, Institute of Pediatrics of Southern Switzerland, Bellinzona, Switzerland
| | - Arianna Vincenti
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Irene Toldo
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Claudio Ancona
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Haemorrhagic Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Ignazio D Errico
- Neuroradiology Unit, Department of Neuroscience, University Hospital of Padua, Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
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Xie Q, Liao YH, He WJ, Han PP, Wu J. Evaluation of Neonatal Cerebral Circulation Under Hypoxic Ischemic Risk Factors Based on Quantitative Analysis of Cerebral Veins with Magnetic Resonance Susceptibility Weighted Imaging. Clin Neuroradiol 2024:10.1007/s00062-024-01432-0. [PMID: 38922421 DOI: 10.1007/s00062-024-01432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To observe the regulation of cerebral circulation in vivo based on image segmentation algorithms for deep learning in medical imaging to automatically detect and quantify the neonatal deep medullary veins (DMVs) on susceptibility weighted imaging (SWI) images. To evaluate early cerebral circulation self-rescue for neonates undergoing risk of cerebral hypoxia-ischaemia in vivo. METHODS SWI images and clinical data of 317 neonates with or without risk of cerebral hypoxia-ischaemia were analyzed. Quantitative parameters showing the number, width, and curvature of DMVs were obtained using an image segmentation algorithm. RESULTS The number of DMVs was greater in males than in females (p < 0.01), and in term than in preterm infants (p = 0.001). The width of DMVs was greater in term than in preterm infants (p < 0.01), in low-risk than in high-risk group (p < 0.01), and in neonates without intracranial extracerebral haemorrhage (ICECH) than with ICECH (p < 0.05). The curvature of DMVs was greater in term than in preterm infants (P < 0.05). The width of both bilateral thalamic veins and anterior caudate nucleus veins were positively correlated with the number of DMVs; the width of bilateral thalamic veins was positively correlated with the width of DMVs. CONCLUSION The DMVs quantification based on image segmentation algorithm may provide more detailed and stable quantitative information in neonate. SWI vein quantification may be an observable indicator for in vivo assessment of cerebral circulation self-regulation in neonatal hypoxic-ischemic brain injury.
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Affiliation(s)
- Qi Xie
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China.
| | - Yan-Hui Liao
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
- Department of Nuclear Medicine, Meizhou, People's Hospital, 514031, Meizhou, China
| | - Wen-Juan He
- Medical Imaging Department of Nansha, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 511457, Guangzhou, China
| | - Peng-Peng Han
- Institute of Software Application Technology, 511458, Guangzhou, China
| | - Jun Wu
- Institute of Software Application Technology, 511458, Guangzhou, China
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3
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Fichera G, Stramare R, Bisogno G, Wyttenbach R, Goeggel BS, Del Grande F, Giraudo C, Lacalamita MC. Neonatal cerebral ultrasound: anatomical variants and age-related diseases. J Ultrasound 2024:10.1007/s40477-024-00914-8. [PMID: 38918318 DOI: 10.1007/s40477-024-00914-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 06/27/2024] Open
Abstract
Cerebral ultrasound is a non-invasive imaging technique widely used for the assessment of brain anatomy and diseases in neonates and infants. Indeed, it allows a precise characterization of common variants such as cavum septum pellucidum or diseases like intraventricular hemorrhage. The aim of this pictorial review is to provide a comprehensive overview of the main ultrasound features of the most common cerebral anatomical variants and disorders detectable by cerebral ultrasound using an age-related approach which could support non-subspecialized radiologists.
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Affiliation(s)
- Giulia Fichera
- Pediatric Radiology, University Hospital of Padova, Padua, Italy.
| | - Roberto Stramare
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health (DCTV), University of Padova, Padua, Italy
| | - Gianni Bisogno
- Pediatric Hematology-Oncology Division, University Hospital of Padova, Padua, Italy
| | - Rolf Wyttenbach
- Imaging Institute of Southern Switzerland EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Barbara Simonetti Goeggel
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Neuropaediatrics, Institute of Paediatrics of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Filippo Del Grande
- Imaging Institute of Southern Switzerland EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
- University of Zurich, Zurich, Switzerland
- Department of Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health (DCTV), University of Padova, Padua, Italy
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Lai LM, Sato TS, Kandemirli SG, AlArab N, Sato Y. Neuroimaging of Neonatal Stroke: Venous Focus. Radiographics 2024; 44:e230117. [PMID: 38206831 DOI: 10.1148/rg.230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Perinatal venous infarcts are underrecognized clinically and at imaging. Neonates may be susceptible to venous infarcts because of hypercoagulable state, compressibility of the dural sinuses and superficial veins due to patent sutures, immature cerebral venous drainage pathways, and drastic physiologic changes of the brain circulation in the perinatal period. About 43% of cases of pediatric cerebral sinovenous thrombosis occur in the neonatal period. Venous infarcts can be recognized by ischemia or hemorrhage that does not respect an arterial territory. Knowledge of venous drainage pathways and territories can help radiologists recognize characteristic venous infarct patterns. Intraventricular hemorrhage in a term neonate with thalamocaudate hemorrhage should raise concern for internal cerebral vein thrombosis. A striato-hippocampal pattern of hemorrhage indicates basal vein of Rosenthal thrombosis. Choroid plexus hemorrhage may be due to obstruction of choroidal veins that drain the internal cerebral vein or basal vein of Rosenthal. Fan-shaped deep medullary venous congestion or thrombosis is due to impaired venous drainage into the subependymal veins, most commonly caused by germinal matrix hemorrhage in the premature infant and impeded flow in the deep venous system in the term infant. Subpial hemorrhage, an underrecognized hemorrhage stroke type, is often observed in the superficial temporal region, and its cause is probably multifactorial. The treatment of cerebral sinovenous thrombosis is anticoagulation, which should be considered even in the presence of intracranial hemorrhage. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Lillian M Lai
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Takashi Shawn Sato
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Sedat Giray Kandemirli
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Natally AlArab
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
| | - Yutaka Sato
- From the Department of Radiology, University of Iowa Stead Family Children's Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1077
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Viaene AN, Nelson EJ, Santi M. Perinatal hypoxic-ischemic brain injury: What's behind the "ribbon effect"? J Neuropathol Exp Neurol 2023; 82:865-875. [PMID: 37595577 DOI: 10.1093/jnen/nlad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
Ribbon effect describes a perceived macroscopic color reversal of the gray and white matter, characterized by a pale cortex and diffusely dusky underlying white matter. This finding is thought to be unique to the perinatal period and indicative of hypoxic-ischemic injury. However, the clinical and microscopic correlates of this macroscopic finding have not been clearly defined. A 21-year retrospective study of autopsies was performed. Ribbon effect was seen in 190 subjects, ages 20 weeks gestation to 9.5 months adjusted age. Clinical associations and radiographic findings were similar in ribbon effect cases and controls. A variety of histologic findings were observed including acute neuronal injury, diffuse white matter gliosis, and white matter necrosis. Only white matter vascular congestion was significantly correlated to the macroscopic severity of ribbon effect; the severity of white matter injury and acute neuronal injury were not significantly correlated to ribbon effect. While hypoxic-ischemic changes were present in nearly all cases of ribbon effect, the location, severity, and chronicity of these changes varied considerably, and similar findings were observed in controls. The presence of ribbon effect therefore does not predict microscopic findings apart from vascular congestion, highlighting the importance of microscopic examination in perinatal brain autopsies.
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Affiliation(s)
- Angela N Viaene
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ernest J Nelson
- Department of Pathology and Laboratory Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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6
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Pin JN, Leonardi L, Nosadini M, Pelizza MF, Capato L, Piretti L, Cavicchiolo ME, Simioni P, Baraldi E, Perilongo G, Luciani M, Sartori S. Deep Medullary Vein Thrombosis in Newborns: A Systematic Literature Review. Neonatology 2023; 120:539-547. [PMID: 37379822 DOI: 10.1159/000530647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Deep medullary vein (DMV) thrombosis is a rare cause of brain damage in both preterm and full-term neonates. In this study, we aimed to collect data on clinical and radiological presentation, treatment, and outcome of neonatal DMV thrombosis. METHODS Systematic literature review on neonatal DMV thrombosis was carried out in PubMed, ClinicalTrial.gov, Scopus, and Web of Science up to December 2022. RESULTS Seventy-five published cases of DMV thrombosis were identified and analysed (preterm newborns were 46%). Neonatal distress, respiratory resuscitation, or need for inotropes were present in 34/75 (45%) of patients. Signs and symptoms at presentation included seizures (38/75, 48%), apnoea (27/75, 36%), lethargy or irritability (26/75, 35%). At magnetic resonance imaging (MRI), fan-shaped linear T2 hypointense lesions were documented in all cases. All had ischaemic injuries, most often involving the frontal (62/74, 84%) and parietal lobes (56/74, 76%). Signs of haemorrhagic infarction were present in 53/54 (98%). Antithrombotic treatment was not mentioned in any of the studies included. Although mortality was low (2/75, 2.6%), a large proportion of patients developed neurological sequelae (intellectual disability in 19/51 [37%] and epilepsy in 9/51 [18%] cases). CONCLUSIONS DMV thrombosis is rarely identified in the literature, even if it is possibly under-recognized or under-reported. Presentation in neonatal age is with seizures and non-specific systemic signs/symptoms that often cause diagnostic delay, despite the pathognomonic MRI picture. The high rate of morbidity, which determines significant social and health costs, requires further in-depth studies aimed at earlier diagnosis and evidence-based prevention and therapeutic strategies.
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Affiliation(s)
- Jacopo Norberto Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Letizia Leonardi
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza,", Padua, Italy
| | - Maria Federica Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Capato
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Piretti
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University Hospital of Padua, Padua, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Giorgio Perilongo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Matteo Luciani
- Department of Paediatric Hematology Oncology, Bambino Gesù Children Hospital IRCSS, Roma, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza,", Padua, Italy
- Department of Neuroscience, University Hospital of Padua, Padua, Italy
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7
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Naik S, Nayak MK, Sahoo T, Bhoi SK. Deep Medullary Vein Thrombosis in a Neonate with Asymptomatic Polycythemia. Neurol India 2023; 71:613-614. [PMID: 37322787 DOI: 10.4103/0028-3886.378709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manoj K Nayak
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tanushree Sahoo
- Department of Neonatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sanjeev K Bhoi
- Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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8
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Zhuang X, Jin K, Li J, Yin Y, Dong X, Lin H. A radiomics-based study of deep medullary veins in infants: Evaluation of neonatal brain injury with hypoxic-ischemic encephalopathy via susceptibility-weighted imaging. Front Neurosci 2023; 16:1093499. [PMID: 36733926 PMCID: PMC9887113 DOI: 10.3389/fnins.2022.1093499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Objective The deep medullary veins (DMVs) can be evaluated using susceptibility-weighted imaging (SWI). This study aimed to apply radiomic analysis of the DMVs to evaluate brain injury in neonatal patients with hypoxic-ischemic encephalopathy (HIE) using SWI. Methods This study included brain magnetic resonance imaging of 190 infants with HIE and 89 controls. All neonates were born at full-term (37+ weeks gestation). To include the DMVs in the regions of interest, manual drawings were performed. A Rad-score was constructed using least absolute shrinkage and selection operator (LASSO) regression to identify the optimal radiomic features. Nomograms were constructed by combining the Rad-score with a clinically independent factor. Receiver operating characteristic curve analysis was applied to evaluate the performance of the different models. Clinical utility was evaluated using a decision curve analysis. Results The combined nomogram model incorporating the Rad-score and clinical independent predictors, was better in predicting HIE (in the training cohort, the area under the curve was 0.97, and in the validation cohort, it was 0.95) and the neurologic outcomes after hypoxic-ischemic (in the training cohort, the area under the curve was 0.91, and in the validation cohort, it was 0.88). Conclusion Based on radiomic signatures and clinical indicators, we developed a combined nomogram model for evaluating neonatal brain injury associated with perinatal asphyxia.
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Affiliation(s)
- Xiamei Zhuang
- Department of Radiology, Hunan Children’s Hospital, Changsha, China
| | - Ke Jin
- Department of Radiology, Hunan Children’s Hospital, Changsha, China,*Correspondence: Ke Jin,
| | - Junwei Li
- Department of Radiology, Hunan Children’s Hospital, Changsha, China
| | - Yan Yin
- Department of Radiology, Hunan Children’s Hospital, Changsha, China
| | - Xiao Dong
- Department of Radiology, Hunan Children’s Hospital, Changsha, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, General Electric (GE) Healthcare, Changsha, China
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Zhuang X, Lin H, Li J, Yin Y, Dong X, Jin K. Radiomics based of deep medullary veins on susceptibility-weighted imaging in infants: predicting the severity of brain injury of neonates with perinatal asphyxia. Eur J Med Res 2023; 28:9. [PMID: 36609425 PMCID: PMC9817267 DOI: 10.1186/s40001-022-00954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study aimed to apply radiomics analysis of the change of deep medullary veins (DMV) on susceptibility-weighted imaging (SWI), and to distinguish mild hypoxic-ischemic encephalopathy (HIE) from moderate-to-severe HIE in neonates. METHODS A total of 190 neonates with HIE (24 mild HIE and 166 moderate-to-severe HIE) were included in this study. All of them were born at 37 gestational weeks or later. The DMVs were manually included in the regions of interest (ROI). For the purpose of identifying optimal radiomics features and to construct Rad-scores, 1316 features were extracted. LASSO regression was used to identify the optimal radiomics features. Using the Red-score and the clinical independent factor, a nomogram was constructed. In order to evaluate the performance of the different models, receiver operating characteristic (ROC) curve analysis was applied. Decision curve analysis (DCA) was implemented to evaluate the clinical utility. RESULTS A total of 15 potential predictors were selected and contributed to Red-score construction. Compared with the radiomics model, the nomogram combined model incorporating Red-score and urea nitrogen did not better distinguish between the mild HIE and moderate-to-severe HIE group. For the training cohort, the AUC of the radiomics model and the combined nomogram model was 0.84 and 0.84. For the validation cohort, the AUC of the radiomics model and the combined nomogram model was 0.80 and 0.79, respectively. The addition of clinical characteristics to the nomogram failed to distinguish mild HIE from moderate-to-severe HIE group. CONCLUSION We developed a radiomics model and combined nomogram model as an indicator to distinguish mild HIE from moderate-to-severe HIE group.
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Affiliation(s)
- Xiamei Zhuang
- grid.440223.30000 0004 1772 5147Department of Radiology, Hunan Children’s Hospital, 86 Ziyuan Road, Yuhua District, Changsha, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Changsha, 410005 China
| | - Junwei Li
- grid.440223.30000 0004 1772 5147Department of Radiology, Hunan Children’s Hospital, 86 Ziyuan Road, Yuhua District, Changsha, China
| | - Yan Yin
- grid.440223.30000 0004 1772 5147Department of Radiology, Hunan Children’s Hospital, 86 Ziyuan Road, Yuhua District, Changsha, China
| | - Xiao Dong
- grid.440223.30000 0004 1772 5147Department of Radiology, Hunan Children’s Hospital, 86 Ziyuan Road, Yuhua District, Changsha, China
| | - Ke Jin
- grid.440223.30000 0004 1772 5147Department of Radiology, Hunan Children’s Hospital, 86 Ziyuan Road, Yuhua District, Changsha, China
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10
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Malik P, Shroff M. Infection and inflammation: radiological insights into patterns of pediatric immune-mediated CNS injury. Neuroradiology 2023; 65:425-439. [PMID: 36534135 PMCID: PMC9761646 DOI: 10.1007/s00234-022-03100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
The central nervous system (CNS) undergoes constant immune surveillance enabled via regionally specialized mechanisms. These include selectively permissive barriers and modifications to interlinked innate and adaptive immune systems that detect and remove an inciting trigger. The end-points of brain injury and edema from these triggers are varied but often follow recognizable patterns due to shared underlying immune drivers. Imaging provides insights to understanding these patterns that often arise from unique interplays of infection, inflammation and genetics. We review the current updates in our understanding of these intersections and through examples of cases from our practice, highlight that infection and inflammation follow diverse yet convergent mechanisms that can challenge the CNS in children.
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Affiliation(s)
- Prateek Malik
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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11
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Ramenghi LA. The Needed Studies Trying to Untangle the Complex Nature of Neonatal Intracranial Bleeds Occurring around Birth. AJNR Am J Neuroradiol 2022; 43:1500-1501. [PMID: 36137660 PMCID: PMC9575530 DOI: 10.3174/ajnr.a7651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- L A Ramenghi
- Istituto Pediatrico "G.Gaslini"DINOGMI Department, University of GenoaItaly
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12
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Hwang M, Haddad S, Tierradentro-Garcia LO, Alves CA, Taylor GA, Darge K. Current understanding and future potential applications of cerebral microvascular imaging in infants. Br J Radiol 2022; 95:20211051. [PMID: 35143338 PMCID: PMC10993979 DOI: 10.1259/bjr.20211051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/16/2021] [Accepted: 01/28/2022] [Indexed: 01/09/2023] Open
Abstract
Microvascular imaging is an advanced Doppler ultrasound technique that detects slow flow in microvessels by suppressing clutter signal and motion-related artifacts. The technique has been applied in several conditions to assess organ perfusion and lesion characteristics. In this pictorial review, we aim to describe current knowledge of the technique, particularly its diagnostic utility in the infant brain, and expand on the unexplored but promising clinical applications of microvascular imaging in the brain with case illustrations.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children’s Hospital of
Philadelphia, Philadelphia,
USA
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania,
Philadelphia, USA
| | - Sophie Haddad
- Department of Radiology, Children’s Hospital of
Philadelphia, Philadelphia,
USA
| | | | - Cesar Augusto Alves
- Department of Radiology, Children’s Hospital of
Philadelphia, Philadelphia,
USA
| | - George A. Taylor
- Department of Radiology, Children’s Hospital of
Philadelphia, Philadelphia,
USA
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania,
Philadelphia, USA
- Department of Radiology, Boston Children’s
Hospital, Boston,
USA
| | - Kassa Darge
- Department of Radiology, Children’s Hospital of
Philadelphia, Philadelphia,
USA
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania,
Philadelphia, USA
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Christensen R, Krishnan P, deVeber G, Dlamini N, MacGregor D, Pulcine E, Moharir M. Cerebral Venous Sinus Thrombosis in Preterm Infants. Stroke 2022; 53:2241-2248. [DOI: 10.1161/strokeaha.121.037621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Neonatal cerebral venous sinus thrombosis (CVST) can lead to brain injury and neurodevelopmental impairments. Previous studies of neonatal CVST have focused on term infants, and studies of preterm infants are lacking. In this study, we examined the clinical and radiological features, treatment and outcome of CVST in preterm infants.
METHODS:
This was a retrospective, consecutive cohort study of preterm infants (gestational age <37 weeks) with radiologically confirmed CVST. All magnetic resonance imaging/MRV and CT/CTV scans were re-reviewed to study thrombus characteristics and pattern of brain injury. Outcome was assessed by the validated pediatric stroke outcome measure at the most recent clinic visit.
RESULTS:
Twenty-six preterm infants with CVST were studied. Of these, 65% were moderate-late preterm (32–37 weeks), 27% very preterm (28–32 weeks), and 8% extreme preterm (<28 weeks). Most (73%) were symptomatic at presentation with seizures or abnormal exam. Transverse (85%) and superior sagittal (42%) sinuses were common sites of thrombosis. Parenchymal brain injury was predominantly periventricular (35%) and deep white matter (31%) in location. Intraventricular hemorrhage occurred in 46%. Most infants (69%) were treated with anticoagulation. No treated infant (including eleven with pretreatment hemorrhage) had new or worsening post-treatment hemorrhage. Outcomes ranged from no deficits (50%), mild-moderate (25%), and severe (25%) impairment.
CONCLUSIONS:
In our sample of preterm infants with CVST, more than one-quarter were asymptomatic. White matter brain lesions predominated and one-half had neurological deficits at follow-up. Anticoagulation of preterm CVST in this small cohort appeared to be safe. Larger studies of preterm CVST are needed.
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Affiliation(s)
- Rhandi Christensen
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (P.K.)
| | - Gabrielle deVeber
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
- Child Health Evaluative Sciences Program, Hospital for Sick Children Research Institute‚ Toronto‚ Ontario‚ Canada (G.d.)
| | - Nomazulu Dlamini
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Daune MacGregor
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Elizabeth Pulcine
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
| | - Mahendranath Moharir
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto‚ Ontario‚ Canada (R.C., G.d., N.D., D.M., E.P., M.M.)
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14
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Reddy N, Doyle M, Hanagandi P, Taranath A, Dahmoush H, Krishnan P, Oztekin O, Boltshauser E, Shroff M, Mankad K. Neuroradiological Mimics of Periventricular Leukomalacia. J Child Neurol 2022; 37:151-167. [PMID: 34937403 DOI: 10.1177/08830738211026052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Periventricular leukomalacia (PVL) is a term reserved to describe white matter injury in the premature brain. In this review article, the authors highlight the common and rare pathologies mimicking the chronic stage of PVL and propose practical clinico-radiological criteria that would aid in diagnosis and management. METHODS AND RESULTS The authors first describe the typical brain MRI (magnetic resonance imaging) features of PVL. Based on their clinical presentation, pathologic entities and their neuroimaging findings were clustered into distinct categories. Three clinical subgroups were identified: healthy children, children with stable/nonprogressive neurological disorder, and those with progressive neurological disorder. The neuroradiological discriminators are described in each subgroup with relevant differential diagnoses. The mimics were broadly classified into normal variants, acquired, and inherited disorders. CONCLUSIONS The term "PVL" should be used appropriately as it reflects its pathomechanism. The phrase "white matter injury of prematurity" or "brain injury of prematurity" is more specific. Discrepancies in imaging and clinical presentation must be tread with caution and warrant further investigations to exclude other possibilities.
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Affiliation(s)
- Nihaal Reddy
- Rainbow Children's Hospital and Tenet Diagnostics, Hyderabad, India
| | - Mary Doyle
- Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
| | - Prasad Hanagandi
- Department of Neuroradiology, King Abdulaziz Medical City, Riyadh Ministry of National Guard Health Affairs, Saudi Arabia
| | - Ajay Taranath
- Department of Radiology, Women's and Children's Hospital, Adelaide, Australia
| | - Hisham Dahmoush
- Department of Radiology, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Pradeep Krishnan
- Department of Pediatric Neuroradiology, The Hospital for Sick Children, Toronto, Canada
| | - Ozgur Oztekin
- Tepecik Research and Education Hospital, Health Science University, Izmir, Turkey
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Steinwiesstrasse, Switzerland
| | - Manohar Shroff
- Department of Pediatric Neuroradiology, The Hospital for Sick Children, Toronto, Canada
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London, UK
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15
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A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography. Diagnostics (Basel) 2021; 11:diagnostics11081511. [PMID: 34441444 PMCID: PMC8394388 DOI: 10.3390/diagnostics11081511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors’ 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended.
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17
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Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke. Pediatr Radiol 2021; 51:675-685. [PMID: 33090246 DOI: 10.1007/s00247-020-04846-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
Perinatal venous stroke has classically been attributed to cerebral sinovenous thrombosis with resultant congestion or thrombosis of the small veins draining the cerebrum. Advances in brain MRI, in particular susceptibility-weighted imaging, have enabled the visualization of the engorged small intracerebral veins, and the spectrum of perinatal venous stroke has expanded to include isolated congestion or thrombosis of the deep medullary veins and the superficial intracerebral veins. Congestion or thrombosis of the deep medullary veins or the superficial intracerebral veins can result in vasogenic edema, cytotoxic edema or hemorrhage in the territory of disrupted venous flow. Deep medullary vein engorgement and superficial medullary vein engorgement have characteristic findings on MRI and should be differentiated from neonatal hemorrhagic stroke.
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18
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Malova M, Morelli E, Cardiello V, Tortora D, Severino M, Calevo MG, Parodi A, De Angelis LC, Minghetti D, Rossi A, Ramenghi LA. Nosological Differences in the Nature of Punctate White Matter Lesions in Preterm Infants. Front Neurol 2021; 12:657461. [PMID: 33995255 PMCID: PMC8117674 DOI: 10.3389/fneur.2021.657461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pathogenesis of punctuate white matter lesions (PWMLs), a mild form of white matter damage observed in preterm infants, is still a matter of debate. Susceptibility-weighted imaging (SWI) allows to differentiate PWMLs based on the presence (SWI+) or absence (SWI-) of hemosiderin, but little is known about the significance of this distinction. This retrospective study aimed to compare neuroradiological and clinical characteristics of SWI+ and SWI- PWMLs. Materials and Methods: MR images of all VLBW infants scanned consecutively at term-equivalent age between April 2012 and May 2018 were retrospectively reviewed, and infants with PWMLs defined as small areas of high T1 and/or low T2 signal in the periventricular white matter were selected and included in the study. Each lesion was analyzed separately and characterized by localization, organization pattern, and distance from the lateral ventricle. Clinical data were retrieved from the department database. Results: A total of 517 PWMLs were registered in 81 patients, with 93 lesions (18%) visible on SWI (SWI+), revealing the presence of hemosiderin deposits. On univariate analysis, compared to SWI- PWML, SWI+ lesions were closer to the ventricle wall, more frequently organized in linear pattern and associated with lower birth weight, lower gestational age, lower admission temperature, need for intubation, bronchopulmonary dysplasia, retinopathy of prematurity, and presence of GMH-IVH. On multivariate analysis, closer distance to the ventricle wall on axial scan and lower birth weight were associated with visibility of PMWLs on SWI (p = 0.003 and p = 0.0001, respectively). Conclusions: Our results suggest a nosological difference between SWI+ and SWI- PWMLs. Other prospective studies are warranted to corroborate these observations.
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Affiliation(s)
- Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Morelli
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Diego Minghetti
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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19
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Benninger KL, Benninger TL, Moore-Clingenpeel M, Ruess L, Rusin JA, Maitre NL. Deep Medullary Vein White Matter Injury Global Severity Score Predicts Neurodevelopmental Impairment. J Child Neurol 2021; 36:253-261. [PMID: 33522373 PMCID: PMC7874519 DOI: 10.1177/0883073820967161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM To examine associations between the deep medullary vein white matter injury global severity scoring system and neurodevelopmental impairment. METHODS This is a prospective observational cohort study of infants born at ≥32 weeks, diagnosed with deep medullary vein thrombosis and infarction on neuroimaging in the first month of life. Developmental testing was performed using validated measures for early, preschool, and school-age follow-up. RESULTS Nineteen (37%) patients had major neurodevelopmental impairment. Global severity score was higher among patients with neurodevelopmental impairment (21.6 vs 13.4, P = .04). Overall, 78% of patients with epilepsy had neurodevelopmental impairment. A greater degree of asymmetry with right-sided injury predominance was associated with lower Bayley-III cognitive scores and presence of neurodevelopmental impairment (P < .01). CONCLUSIONS Results suggest a need for targeted clinical surveillance for patients with a high global severity score and/or asymmetric, predominantly right cerebral white matter injury and for those who develop epilepsy.
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Affiliation(s)
- Kristen L. Benninger
- Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Columbus OH,Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus OH
| | | | - Melissa Moore-Clingenpeel
- Biostatistics Core, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus OH
| | - Lynne Ruess
- Department of Radiology, Nationwide Children’s Hospital, Columbus OH
| | - Jerome A. Rusin
- Department of Radiology, Nationwide Children’s Hospital, Columbus OH
| | - Nathalie L. Maitre
- Department of Pediatrics, Division of Neonatology, Nationwide Children’s Hospital, Columbus OH,Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus OH
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20
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Alves Fonseca AP, Melo de Carvalho R, Padula M, de Cassia Maciel Pincerato R. Deep Medullary Vein Thrombosis in a Neonate: A Peculiar MRI Pattern. Neurology 2021; 96:492-493. [PMID: 33441458 DOI: 10.1212/wnl.0000000000011502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ana Paula Alves Fonseca
- From the Division of Neuroradiology, Americas Serviços Médicos-United Health Group Brazil, São Paulo
| | - Ruann Melo de Carvalho
- From the Division of Neuroradiology, Americas Serviços Médicos-United Health Group Brazil, São Paulo
| | - Mário Padula
- From the Division of Neuroradiology, Americas Serviços Médicos-United Health Group Brazil, São Paulo
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21
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Cavalcanti DD, Raz E, Shapiro M, Dehkharghani S, Yaghi S, Lillemoe K, Nossek E, Torres J, Jain R, Riina HA, Radmanesh A, Nelson PK. Cerebral Venous Thrombosis Associated with COVID-19. AJNR Am J Neuroradiol 2020; 41:1370-1376. [PMID: 32554424 PMCID: PMC7658892 DOI: 10.3174/ajnr.a6644] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 12/23/2022]
Abstract
Despite the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. We report a unique series of young patients with COVID-19 presenting with cerebral venous system thrombosis. Three patients younger than 41 years of age with confirmed Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov-2) infection had neurologic findings related to cerebral venous thrombosis. They were admitted during the short period of 10 days between March and April 2020 and were managed in an academic institution in a large city. One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins. Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2-7 days). One patient was diagnosed with new-onset diabetic ketoacidosis, and another one used oral contraceptive pills. Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir-ritonavir. All patients had a fatal outcome. Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19. We urge awareness of this atypical manifestation.
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Affiliation(s)
- D D Cavalcanti
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - E Raz
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - M Shapiro
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - S Dehkharghani
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - S Yaghi
- Neurology (S.Y., K.L., J.T.)
| | | | - E Nossek
- Neurosurgery (E.N., H.A.R.), NYU Grossman School of Medicine, New York, New York
| | | | - R Jain
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - H A Riina
- Neurosurgery (E.N., H.A.R.), NYU Grossman School of Medicine, New York, New York
| | - A Radmanesh
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - P K Nelson
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
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22
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Abstract
Significant advances in the field of neonatal imaging has resulted in the generation of large complex data sets of relevant information for routine daily clinical practice, and basic and translational research. The evaluation of this data is a complex task for the neonatal imager who must distinguish normal and incidental findings from clinically significant abnormalities which are often adjunctive data points applicable to clinical evaluation and treatment. This review provides an overview of the imaging manifestations of disease processes commonly encountered in the neonatal brain. Since MRI is currently the highest yield technique for the diagnosis and characterization of the normal and abnormal brain, it is therefore the focus of the majority of this review. When applicable, discussion of some of the pertinent known pathophysiology and neuropathological aspects of disease processes are reviewed.
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23
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Kim HG, Choi JW, Han M, Lee JH, Lee HS. Texture analysis of deep medullary veins on susceptibility-weighted imaging in infants: evaluating developmental and ischemic changes. Eur Radiol 2020; 30:2594-2603. [DOI: 10.1007/s00330-019-06618-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/07/2019] [Accepted: 12/11/2019] [Indexed: 12/28/2022]
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Mazini B, Bonvin C, Gailloud P, San Millán D. Isolated superior striate vein thrombosis in adults. Interv Neuroradiol 2020; 26:446-450. [PMID: 31969077 DOI: 10.1177/1591019919900825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Isolated cerebral deep medullary vein thrombosis has been described in the setting of hemorrhagic periventricular white matter lesions in preterm and full-term neonates, but to the best of our knowledge, has never been reported in adults. We present two cases of isolated thrombosis of the superior striate vein occurring in adults that could be analogous to deep medullary vein thrombosis in that they involve deep cerebral veins only without thrombosis of the subependymal or internal cerebral veins. CASE DESCRIPTION Two women aged 20 and 39, presented with transient neurological deficits and headache. Diagnosis of isolated superior striate vein thrombosis was based on CT and MRI findings with long term imaging follow-up. Both patients evolved favorably under conservative treatment without anticoagulation. Thrombophilia workup was negative and both patients were active smokers under oral contraception. CONCLUSION Isolated superior striate vein thrombosis is a rare form of intracranial venous thrombosis and should be considered in the differential diagnosis of stroke-like episodes with headache in adults. Isolated superior striate vein thrombosis presents with characteristic imaging features on CT and MRI.
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Affiliation(s)
- Bianca Mazini
- Service of Diagnostic and intervention Radiology, Hospital of Sion, Centre Hospitalier du Valais Romand, Switzerland
| | - Christophe Bonvin
- Neurology Service, Hospital of Sion, Centre Hospitalier du Valais Romand, Switzerland
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Diego San Millán
- Unit of Neuroradiology, Service of Diagnostic and Intervention Radiology, Hospital of Sion, Centre Hospitalier du Valais Romand, Switzerland
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25
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Chen D, Sun J, Li Q, Bai W, Mao J. An Important Finding of White Matter Injury in Late Preterm Infant: Deep Medullary Vein Involvement. Front Pediatr 2020; 8:597567. [PMID: 33392116 PMCID: PMC7773939 DOI: 10.3389/fped.2020.597567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To investigate high risk factors and magnetic resonance imaging (MRI) features in late preterm infants with severe white matter injury (WMI) associated with abnormal deep medullary veins (DMVs). Materials and Methods: Preterm infants with severe WMI, who were hospitalized in Shengjing Hospital from 1st January 2009 to 31st December 2018, were enrolled in this retrospective study. High risk factors and MRI characteristics of infants with abnormal DMVs were analyzed and compared with those of infants without DMV abnormalities. Results: A total of 2032 late preterm infants were examined by MRI; 71 cases (3.5%) had severe WMI and 15 of these (21.1%) had abnormal DMVs. The incidence of maternal diabetes was higher in infants with abnormal DMVs and neonatal convulsions were more likely (P < 0.05). The incidence of grade IV injury (P < 0.05), white matter periventricular cysts and thalamic injury (P < 0.01), cerebral venous sinus thrombus (P < 0.01) and germinal matrix/intraventricular hemorrhage (P < 0.05) were higher in infants with abnormal DMVs than in infants with normal DMVs. Conclusions: Congestion/thrombosis of DMVs may be an important cause of severe WMI in late preterm infants, especially in periventricular leukomalacia-like WMI. WMI with abnormal DMVs is more likely to lead to thalamic injury.
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Affiliation(s)
- Dan Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiuyu Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wenjuan Bai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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26
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Venous pathologies in paediatric neuroradiology: from foetal to adolescent life. Neuroradiology 2019; 62:15-37. [PMID: 31707531 DOI: 10.1007/s00234-019-02294-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
The interpretation of cerebral venous pathologies in paediatric practice is challenging as there are several normal anatomical variants, and the pathologies are diverse, involving the venous system through direct and indirect mechanisms. This paper aims to provide a comprehensive review of these entities, as their awareness can avoid potential diagnostic pitfalls. We also propose a practical classification system of paediatric cerebral venous pathologies, which will enable more accurate reporting of the neuroimaging findings, as relevant to the underlying pathogenesis of these conditions. The proposed classification system comprises of the following main groups: arterio-venous shunting-related disorders, primary venous malformations and veno-occlusive disorders. A multimodal imaging approach has been included in the relevant subsections, with a brief overview of the modality-specific pitfalls that can also limit interpretation of the neuroimaging. The article also summarises the current literature and international practices in terms of management options and outcomes in specific disease entities.
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27
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Canedo-Antelo M, Baleato-González S, Mosqueira AJ, Casas-Martínez J, Oleaga L, Vilanova JC, Luna-Alcalá A, García-Figueiras R. Radiologic Clues to Cerebral Venous Thrombosis. Radiographics 2019; 39:1611-1628. [DOI: 10.1148/rg.2019190015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Parodi A, Malova M, Cardiello V, Raffa S, Re M, Calevo MG, Severino M, Tortora D, Morana G, Rossi A, Ramenghi LA. Punctate white matter lesions of preterm infants: Risk factor analysis. Eur J Paediatr Neurol 2019; 23:733-739. [PMID: 31307922 DOI: 10.1016/j.ejpn.2019.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022]
Abstract
AIM Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants. METHODS Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI- lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML. RESULTS 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions. CONCLUSIONS Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI- lesions is crucial as they have different risk factors and may likely represent two different entities.
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Affiliation(s)
- Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy.
| | | | - Sarah Raffa
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Martina Re
- Neonatal Intensive Care Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology, Biostatistics and Committees Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | | | | | - Giovanni Morana
- Neuroradiology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
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Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage. J Perinatol 2019; 39:517-518. [PMID: 30655595 DOI: 10.1038/s41372-018-0307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/09/2022]
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Benninger KL, Maitre NL, Ruess L, Rusin JA. MR Imaging Scoring System for White Matter Injury after Deep Medullary Vein Thrombosis and Infarction in Neonates. AJNR Am J Neuroradiol 2019; 40:347-352. [PMID: 30655251 DOI: 10.3174/ajnr.a5940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/01/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Advanced imaging techniques have allowed earlier and more accurate detection of cerebral deep medullary vein thrombosis and infarction. Our objective was to develop an MR imaging scoring system to evaluate the severity of white matter injury in neonates with deep medullary vein thrombosis and infarction. MATERIALS AND METHODS This was a retrospective study of infants born ≥32 weeks' gestation (2000-2016) diagnosed with deep medullary vein thrombosis and infarction on neuroimaging in the first 30 days of life. A 102-point deep medullary vein white matter injury global severity score was developed. MR images were scored by 2 pediatric radiologists. Subject clinical data and regional and global severity scores were recorded. RESULTS Fifty-one patients (mean gestational age, 37.3 ± 2.2 weeks; mean birth weight, 3182 ± 720 g) were included with a mean age at diagnosis via MR imaging of postnatal day 10.1 ± 6.1. Global severity scores ranged from 1 to 53, with a median score of 11 (interquartile range, 5-25). Lesions were more common in the frontal and parietal regions and less common in the occipital and temporal regions. Fifty-five percent of the group had neonatal seizures. No difference in perinatal risk factors (gestational age, birthweight, 5-minute Apgar score, chorioamnionitis, delivery room resuscitation, ventilator, or inotrope requirement) was observed among severity score quartiles. CONCLUSIONS An MR imaging scoring system provides a comprehensive and objective classification of WM injury after deep medullary vein thrombosis and infarction in late preterm and term neonates. The global severity score is independent of gestational age and other antenatal risk factors, consistent with presentation in previously healthy-appearing neonates.
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Affiliation(s)
- K L Benninger
- From the Departments of Pediatrics and Center for Perinatal Research (K.L.B., N.L.M.) .,Wexner Medical Center (K.L.B., N.L.M., L.R., J.A.R.), Ohio State University, Columbus, Ohio
| | - N L Maitre
- From the Departments of Pediatrics and Center for Perinatal Research (K.L.B., N.L.M.).,Wexner Medical Center (K.L.B., N.L.M., L.R., J.A.R.), Ohio State University, Columbus, Ohio
| | - L Ruess
- Radiology (L.R., J.A.R.), Nationwide Children's Hospital, Columbus, Ohio.,Wexner Medical Center (K.L.B., N.L.M., L.R., J.A.R.), Ohio State University, Columbus, Ohio
| | - J A Rusin
- Radiology (L.R., J.A.R.), Nationwide Children's Hospital, Columbus, Ohio.,Wexner Medical Center (K.L.B., N.L.M., L.R., J.A.R.), Ohio State University, Columbus, Ohio
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Vilan A, Ribeiro JM, Reis C, Sampaio L. Deep Medullary Veins and Brain Injury. J Pediatr 2018; 200:290-290.e1. [PMID: 29731359 DOI: 10.1016/j.jpeds.2018.03.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Luísa Sampaio
- Neuroradiology Department; Centro Hospitalar de São João; Porto, Portugal
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Linscott LL, Leach JL, Jones BV, Abruzzo TA. Imaging patterns of venous-related brain injury in children. Pediatr Radiol 2017; 47:1828-1838. [PMID: 29149371 DOI: 10.1007/s00247-017-3975-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/10/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022]
Abstract
Venous-related brain injury is a common form of cerebrovascular injury in children and encompasses a diverse group of cerebrovascular diagnoses. The purpose of this pictorial essay is to introduce the relevant anatomy, pathophysiology and various imaging patterns of venous-related cerebral injury in children. Unifying concepts to better understand the effects of venous hypertension in the developing brain will be emphasized. These unifying concepts will provide the imaging professional with a conceptual framework to better understand and confidently identify imaging patterns of venous-related cerebral injury.
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Affiliation(s)
- Luke L Linscott
- Department of Radiology, Primary Children's Hospital, University of Utah School of Medicine, 100 Mario Capecchi Drive, Salt Lake City, UT, 84113, USA.
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Todd A Abruzzo
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Taoka T, Fukusumi A, Miyasaka T, Kawai H, Nakane T, Kichikawa K, Naganawa S. Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders. Radiographics 2017; 37:281-297. [PMID: 28076020 DOI: 10.1148/rg.2017160061] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images. ©RSNA, 2017.
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Affiliation(s)
- Toshiaki Taoka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Akio Fukusumi
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiteru Miyasaka
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Hisashi Kawai
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Toshiki Nakane
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Kimihiko Kichikawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
| | - Shinji Naganawa
- From the Department of Radiology, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan (T.T., H.K., T.N., S.N.); and Department of Radiology, Nara Medical University, Kashihara, Japan (A.F., T.M., K.K.)
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Monti S, Cocozza S, Borrelli P, Straub S, Ladd ME, Salvatore M, Tedeschi E, Palma G. MAVEN: An Algorithm for Multi-Parametric Automated Segmentation of Brain Veins From Gradient Echo Acquisitions. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1054-1065. [PMID: 28237923 DOI: 10.1109/tmi.2016.2645286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cerebral vein analysis provides a chance to study, from an unusual viewpoint, an entire class of brain diseases, including neurodegenerative disorders and traumatic brain injuries. Manual segmentation approaches can be used to assess vascular anatomy, but they are observer-dependent and time-consuming; therefore, automated approaches are desirable, as they also improve reproducibility. In this paper, a new, fully automated algorithm, based on structural, morphological, and relaxometric information, is proposed to segment the entire cerebral venous system from MR images. The algorithm for multi-parametric automated segmentation of brain VEiNs (MAVEN) is based on a combined investigation of multi-parametric information that allows for rejection of false positives and detection of thin vessels. The method is tested on gradient echo brain data sets acquired at 1.5, 3, and 7 T. It is compared to previous methods against manual segmentation, and its inter-scan reproducibility is assessed. The achieved accuracy and reproducibility are good, meaning that MAVEN outperforms previous methods on both quantitative and qualitative analyses. It is usable at all the field strengths explored, showing comparable accuracy scores, with no need for algorithm parameter adjustments, and thus, it is a promising candidate for the characterization of the venous tree topology.
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Wang LW, Lin YC, Tu YF, Wang ST, Huang CC. Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants. Neonatology 2017; 111:86-92. [PMID: 27643988 DOI: 10.1159/000448615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cystic periventricular leukomalacia (cPVL) is the most severe white matter injury and is often associated with intraventricular hemorrhage (IVH) in preterm infants. OBJECTIVE The aim of this study was to investigate the prevalence, risk factors and neurodevelopmental outcomes of isolated cPVL and cPVL with low-grade and high-grade IVH in premature infants. METHODS From 2001 to 2012, 9,964 infants with <31 weeks' gestational age (GA) admitted to Taiwan hospitals were enrolled. cPVL was classified into three groups: isolated cPVL, cPVL with low-grade (I/II) IVH, and cPVL with high-grade (III) IVH. RESULTS Of 7,805 infants with complete ultrasound data, 286 (3.7%) had cPVL. Among the cPVL infants, 93 (32.5%) were isolated, 118 (41.3%) had low-grade IVH and 75 (26.2%) had high-grade IVH. The risk of cPVL with IVH was significantly higher among infants with <27 weeks' GA than those with ≥27 weeks' GA, in contrast to that of isolated cPVL. Using infants without cPVL and IVH as the reference group, the most significant predictor of isolated cPVL was neonatal sepsis (odds ratio 2.39; 95% confidence interval 1.52-3.77), while 5-min Apgar score <5 (2.50; 1.48-4.21) and prolonged mechanical ventilation (2.19; 1.42-3.42) were associated with cPVL with low-grade IVH, and GA <27 weeks (2.63; 1.56-4.42), pneumothorax (3.04; 1.40-6.65) and prolonged mechanical ventilation (3.36; 1.88-6.01) contributed to cPVL with high-grade IVH. cPVL infants with low-grade and high-grade IVH had a higher risk of abnormal neurodevelopmental outcomes than infants with isolated cPVL at the age of 24 months. CONCLUSIONS Isolated cPVL, cPVL with low-grade IVH and cPVL with high-grade IVH had different risk factors and neurodevelopmental outcomes, suggestive of different causal pathways.
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Affiliation(s)
- Lan-Wan Wang
- Department of Pediatrics, Chi Mei Medical Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan, ROC
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Ho ML, Patton AC, DeLone DR, Kim H, Gilbertson JR, Felmlee J, Watson RE. Brain Injury in the Preterm and Term Neonate. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lolli V, Molinari F, Pruvo JP, Soto Ares G. Radiological and clinical features of cerebral sinovenous thrombosis in newborns and older children. J Neuroradiol 2016; 43:280-9. [PMID: 26970861 DOI: 10.1016/j.neurad.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/08/2015] [Accepted: 12/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral sinovenous thrombosis (CSVT) represents an increasingly recognized cause of pediatric stroke. Our purpose was to assess gender and age differences in the etiology, clinical presentation, and imaging features of CSVT in neonates and older children. METHODS Subjects aged newborn to 18 years diagnosed with CSVT at the Lille university hospital between 2011 and 2014 were included. RESULTS Eleven neonates and 16 non-neonates constituted the study population. The incidence of CSVT was significantly higher in male newborns. Clinical presentation did not vary significantly between the groups. Risk factors were age-dependent, with acute systemic illnesses significantly predominating in neonates (54%), whereas local infections, prothrombotic conditions, and trauma were more common in older children (36, 27, and 27% respectively). No predisposing factor could be identified in 36% of the neonates as compared to less than 5% of the non-neonates. Thrombosis of the deep venous structures was documented in 73% of the neonates whereas involvement of the superficial sinuses was significantly more frequent in the non-neonates group. Venous infarctions and extraparenchymal hemorrhages were significantly more frequent in the neonates group. CONCLUSION Male patients are at higher risk for CSVT than females. In neonates, involvement of the deep venous structures is significantly more common. Brain parenchymal and extraparenchymal changes occur more frequently in this age group than in older children.
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Affiliation(s)
- Valentina Lolli
- Radiology department, Erasmus university hospital, 808, route de Lennik, 1070 Brussels, Belgium.
| | | | - Jean-Pierre Pruvo
- Neuroradiology department, Roger-Salengro hospital, 59037 Lille, France
| | - Gustavo Soto Ares
- Neuroradiology department, Roger-Salengro hospital, 59037 Lille, France
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Konanki R, Varma DR, Ratha C, Lingappa L, Shah N. Teaching NeuroImages: Fetal deep medullary vein thrombosis presenting as progressive intracerebral hemorrhage. Neurology 2015; 85:e5-6. [PMID: 26150600 DOI: 10.1212/wnl.0000000000001719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ramesh Konanki
- From the Departments of Neurology (R.K., N.S., L.L.) and Fetal Medicine (C.R.), Rainbow Hospital for Women and Children; and the Department of Neuroradiology (D.R.V.), Mediciti Hospitals, Hyderabad, India.
| | - Dandu Ravi Varma
- From the Departments of Neurology (R.K., N.S., L.L.) and Fetal Medicine (C.R.), Rainbow Hospital for Women and Children; and the Department of Neuroradiology (D.R.V.), Mediciti Hospitals, Hyderabad, India
| | - Chinmayee Ratha
- From the Departments of Neurology (R.K., N.S., L.L.) and Fetal Medicine (C.R.), Rainbow Hospital for Women and Children; and the Department of Neuroradiology (D.R.V.), Mediciti Hospitals, Hyderabad, India
| | - Lokesh Lingappa
- From the Departments of Neurology (R.K., N.S., L.L.) and Fetal Medicine (C.R.), Rainbow Hospital for Women and Children; and the Department of Neuroradiology (D.R.V.), Mediciti Hospitals, Hyderabad, India
| | - Nikit Shah
- From the Departments of Neurology (R.K., N.S., L.L.) and Fetal Medicine (C.R.), Rainbow Hospital for Women and Children; and the Department of Neuroradiology (D.R.V.), Mediciti Hospitals, Hyderabad, India
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Dinan D, Daneman A, Guimaraes CV, Chauvin NA, Victoria T, Epelman M. Easily Overlooked Sonographic Findings in the Evaluation of Neonatal Encephalopathy: Lessons Learned From Magnetic Resonance Imaging. Semin Ultrasound CT MR 2014; 35:627-51. [DOI: 10.1053/j.sult.2014.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Cavalleri F, Lugli L, Pugliese M, D'Amico R, Todeschini A, Della Casa E, Gallo C, Frassoldati R, Ferrari F. Prognostic value of diffusion-weighted imaging summation scores or apparent diffusion coefficient maps in newborns with hypoxic-ischemic encephalopathy. Pediatr Radiol 2014; 44:1141-54. [PMID: 24715056 DOI: 10.1007/s00247-014-2945-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/23/2014] [Accepted: 02/19/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND The diagnostic and prognostic assessment of newborn infants with hypoxic-ischemic encephalopathy (HIE) comprises, among other tools, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps. OBJECTIVE To compare the ability of DWI and ADC maps in newborns with HIE to predict the neurodevelopmental outcome at 2 years of age. MATERIALS AND METHODS Thirty-four term newborns with HIE admitted to the Neonatal Intensive Care Unit of Modena University Hospital from 2004 to 2008 were consecutively enrolled in the study. All newborns received EEG, conventional MRI and DWI within the first week of life. DWI was analyzed by means of summation (S) score and regional ADC measurements. Neurodevelopmental outcome was assessed with a standard 1-4 scale and the Griffiths Mental Developmental Scales - Revised (GMDS-R). RESULTS When the outcome was evaluated with a standard 1-4 scale, the DWI S scores showed very high area under the curve (AUC) (0.89) whereas regional ADC measurements in specific subregions had relatively modest predictive value. The lentiform nucleus was the region with the highest AUC (0.78). When GMDS-R were considered, DWI S scores were good to excellent predictors for some GMDS-R subscales. The predictive value of ADC measurements was both region- and subscale-specific. In particular, ADC measurements in some regions (basal ganglia, white matter or rolandic cortex) were excellent predictors for specific GMDS-R with AUCs up to 0.93. CONCLUSIONS DWI S scores showed the highest prognostic value for the neurological outcome at 2 years of age. Regional ADC measurements in specific subregions proved to be highly prognostic for specific neurodevelopmental outcomes.
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Affiliation(s)
- Francesca Cavalleri
- Neuroradiology Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino Estense di Modena, Azienda Unità Sanitaria Locale di Modena, via Giardini 1355, Modena, 41100, Italy,
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Dai Y, Dong S, Zhu M, Wu D, Zhong Y. Visualizing cerebral veins in fetal brain using susceptibility-weighted MRI. Clin Radiol 2014; 69:e392-7. [PMID: 25060932 DOI: 10.1016/j.crad.2014.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/12/2023]
Abstract
AIM To explore the feasibility of two-dimensional (2D) susceptibility-weighted imaging (SWI) in the visualization of cerebral veins in the foetal brain. MATERIALS AND METHODS Forty-two pregnant healthy women (gestational age: 19-37 weeks, mean: 28.5 ± 7.1 weeks) underwent SWI examination using a 1.5 T MRI system. Two neurologists independently analysed all magnetic resonance imaging (MRI) studies. The relationship between the veins detected and the gestational age was investigated. The prominence of veins was assessed using a categorical score. RESULTS In total, 167 veins were detected by SWI in 29 subjects with a symmetric hemisphere distribution (p > 0.05). An additional vein was detected by SWI biweekly from 24 weeks of gestation. Most veins of Galen and internal cerebral veins on SWI images were prominent, whereas others were faint or moderate. CONCLUSION SWI appears to be a feasible method of detecting cerebral veins in the foetal brain.
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Affiliation(s)
- Y Dai
- Philips Healthcare, People's Republic of China
| | - S Dong
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, People's Republic of China
| | - M Zhu
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, People's Republic of China.
| | - D Wu
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, East China Normal University, People's Republic of China
| | - Y Zhong
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, People's Republic of China
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Sannia A, Natalizia AR, Parodi A, Malova M, Fumagalli M, Rossi A, Ramenghi LA. Different gestational ages and changing vulnerability of the premature brain. J Matern Fetal Neonatal Med 2013; 28 Suppl 1:2268-72. [PMID: 23968292 DOI: 10.3109/14767058.2013.796166] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recent decades, there has been a general increase in survival rates of preterm and low birth weight infants, but this overall decrease in perinatal mortality has not been accompanied by a decrease in long-term physical and mental disability. In order to reduce the long-term sequelae of prematurity and to establish preventive measures, it is important to identify risk factors since the main determinant of specific vulnerability to different types of lesions is gestational age. The regional tissue vulnerability at a given gestational age is probably determined by the local metabolic requirements together with specific cell characteristics and their level of maturation. In this article, we discuss the most common neonatal cerebral lesions (cerebellar haemorrhage, germinal matrix intraventricular haemorrhage, periventricular leukomalacia, arterial ischaemic stroke, cerebral vein sinus thrombosis and hypoxic-ischaemic encephalopathy) related to the gestational age-dependent vulnerability of the premature brain.
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Affiliation(s)
- Andrea Sannia
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Anna R Natalizia
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Alessandro Parodi
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Mariya Malova
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Monica Fumagalli
- b NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano , Milan , Italy , and
| | - Andrea Rossi
- c Pediatric Neuroradiology Unit , Istituto Giannina Gaslini , Genova , Italy
| | - Luca A Ramenghi
- a Neonatal Intensive Care Unit , Istituto Giannina Gaslini , Genova , Italy
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The premature brain: developmental and lesional anatomy. Neuroradiology 2013; 55 Suppl 2:23-40. [DOI: 10.1007/s00234-013-1231-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 01/14/2023]
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Heemskerk AM, Leemans A, Plaisier A, Pieterman K, Lequin MH, Dudink J. Acquisition guidelines and quality assessment tools for analyzing neonatal diffusion tensor MRI data. AJNR Am J Neuroradiol 2013; 34:1496-505. [PMID: 23518355 DOI: 10.3174/ajnr.a3465] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diffusion tensor imaging is a valuable measure in clinical settings to assess diagnosis and prognosis of neonatal brain development. However, obtaining reliable images is not straightforward because of the tissue characteristics of the neonatal brain and the high likelihood of motion artifacts. In this review, we present guidelines on how to acquire DTI data of the neonatal brain and recommend high-quality data acquisition and processing as an essential means to obtain accurate and robust parametric maps. Sudden head movements are problematic for DTI in neonates, and these may lead to incorrect values. We describe strategies to minimize the corrupting effects both in terms of acquisition (eg, more gradient directions) and postprocessing (eg, tensor estimation methods). In addition, tools are described that can help assess whether a dataset is of sufficient quality for further assessment.
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Affiliation(s)
- A M Heemskerk
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
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